| NPI | 1942680418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1013249) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 263484) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-31 |
| Last Update Date | 2023-03-20 |